Gastroenterology

Gastroenterology

Volume 130, Issue 1, January 2006, Pages 65-72
Gastroenterology

Clinical–alimentary tract
Age-Specific Incidence of Helicobacter pylori

https://doi.org/10.1053/j.gastro.2005.11.004Get rights and content

Background & Aims: Helicobacter pylori is most likely acquired in childhood, but the incidence of infection has not been determined prospectively by using an appropriate noninvasive test. The aim of this study was to determine the age-specific incidence of Helicobacter pylori infection in children and the risk factors for infection.

Methods: Three hundred twenty-seven healthy index children between 24 and 48 months of age were enrolled over 15 months. At baseline, the Helicobacter pylori infection status of each index child and his or her older siblings and parents was assessed by using the carbon 13–urea breath test. All noninfected index children were then followed up with an annual carbon 13–urea breath test for 4 years to determine whether they became infected with Helicobacter pylori and, if so, the age at first infection. Information on potential risk factors was collected at baseline and each subsequent visit.

Results: At baseline assessment, 28 of 327 (8.6%) index children were infected with Helicobacter pylori. The mean age of the 28 infected children was 32.78 months (SD, 5.14 months). Over the next 4 years, 279 index children not infected at baseline contributed 970 person-years of follow-up to the study. During this time, 20 children became infected with Helicobacter pylori. The rate of infection per 100 person-years of follow-up was highest in the 2–3-year age group (5.05 per 100 person-years of follow-up (95% confidence interval, 1.64–11.78) and declined progressively as children aged. Only 1 child became infected after 5 years of age. Having an infected mother, an infected older sibling, and delayed weaning from a feeding bottle (ie, after 24 months of age) were all risk factors for infection.

Conclusions: Children who become infected with Helicobacter pylori are infected at a very young age, and the risk of infection declines rapidly after 5 years of age. These findings have important implications for studies on the mode of transmission of infection.

Section snippets

Methods

Three hundred twenty-seven healthy index children between 24 and 48 months of age were enrolled. Index children were enrolled over a 15-month period (October 1997 to December 1998). At baseline, the H pylori infection status of each index child was assessed by using the 13C-UBT. All noninfected index children were then followed up with annual 13C-UBT for 4 years to determine whether they became infected with H pylori and, if so, the age at first infection. Information on potential risk factors

Results

Three hundred twenty-seven index children were enrolled in the study from 15 family practices. Seventy-five percent of children resided in the greater Dublin city area, and the remainder lived in 2 rural towns (Mallow, Co Cork, and Kingscourt, Co Cavan, Ireland).

After baseline assessment, 37 (11.3%) noninfected index children were lost to follow-up over the subsequent 4 years (Figure 1). Twenty of these 37 were lost between baseline and the date they were due to have their first annual

Discussion

This is the first prospective study to examine the age-specific incidence of H pylori in children. This study was specifically designed to examine the incidence of H pylori in children >24 months of age by using a valid diagnostic test with strict a priori criteria for the classification of H pylori infection status. Information on risk factors was collected when or before infection occurred. The results show that children in a developed country who become infected with H pylori are infected at

Conclusion

This is the first prospective study on the incidence of H pylori infection. This study shows that most young children with H pylori are infected before the age of 3 years and that the risk of infection is very low after 5 years of age. Having an infected mother, an infected older sibling, or not being weaned from a bottle by 2 years of age are all independent and statistically significant risk factors for infection. This finding that children become infected at a very young age has important

References (47)

  • E. Hentschel et al.

    Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer

    N Engl J Med

    (1993)
  • J.G. Coughlan et al.

    Campylobacter pylori and recurrence of duodenal ulcers—a 12 month follow up study

    Lancet

    (1987)
  • N. Goggin et al.

    Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease

    Arch Dis Child

    (1998)
  • J. Parsonnet

    Helicobacter pylorithe size of the problem

    Gut

    (1998)
  • N. Banatvala et al.

    The cohort effect and Helicobacter pylori

    J Infect Dis

    (1993)
  • S. Suerbaum et al.

    Helicobacter pylori infection

    N Engl J Med

    (2002)
  • B. Drumm et al.

    Intrafamilial clustering of Helicobacter pylori infection

    N Engl J Med

    (1990)
  • H. Malaty et al.

    Transmission of Helicobacter pylori infection. Studies in families of healthy individuals

    Scand J Gastroenterol

    (1991)
  • Y. Lu et al.

    Isolation and genotyping of Helicobacter pylori from untreated municipal wastewater

    Appl Environ Microbiol

    (2002)
  • M. Ashorn et al.

    Helicobacter pylori infection in Finnish children and adolescents. A serologic cross-sectional and follow-up study

    Scand J Gastroenterol

    (1995)
  • H.M. Mitchell et al.

    Epidemiology of Helicobacter pylori in Southern Chinaidentification of early childhood as the critical period for acquisition

    J Infect Dis

    (1992)
  • M. Granstrom et al.

    Seroepidemiology of Helicobacter pylori infection in a cohort of children monitored from 6 months to 11 years of age

    J Clin Microbiol

    (1997)
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